Efectos de la manipulación lumbar y técnica de inducción miofascial toracolumbar sobre el patrón de activación del erector espinal / Effects of lumbar spine manipulation and thoracolumbar myofascial induction technique on the spinae erector activation pattern

Objetivo Estudiar el comportamiento del músculo erector espinal así como el rango de movimiento (ROM) lumbar durante la flexo-extensión de tronco, tras la aplicación de una técnica manipulativa y una técnica de inducción miofascial. Hipótesis Tras dichas técnicas podría haber una ganancia de ROM articular y una disminución en la intensidad de la actividad electromiográfica (EMG) del erector espinal. Metodología En 17 sujetos voluntarios sanos se registraron simultáneamente la actividad EMG de superficie del erector espinal y el ROM lumbar, durante la realización de cinco flexo-extensiones de tronco, antes y después de cada una de las técnicas. Metodología Las variables del estudio fueron los porcentajes de flexión lumbar al inicio y al final del silencio mioeléctrico del erector espinal, la actividad EMG media durante ese tiempo y la actividad EMG máxima y media del erector espinal durante sus contracciones concéntrica y excéntrica. Resultados Tras la técnica miofascial se observó una disminución significativa en la actividad EMG media del erector espinal durante la contracción excéntrica, así como un aumento del porcentaje de flexión lumbar en el inicio del silencio.Conclusión Tras una intervención combinada de manipulación vertebral a nivel de L3 y una técnica de inducción miofascial de la fascia toracolumbar, el silencio electromiográfico del erector espinal aparece después y la contracción es menos intensa en la fase excéntrica, lo que podría deberse a una inhibición de dicha musculatura (AU)

Objective To study erector spinae behavior and lumbar range of movement (ROM) during trunk flexion and extension, following the application of a spinal manipulation and a myofascial induction technique.HypothesisThe application of these techniques could cause an increase in lumbar ROM and a decrease in the electromyographic activity (EMG) of erector spinae.Methodology Surface EMG of erector spinae and lumbar ROM during five trunk flexion and extension, before and after both techniques, were recorded in 17 healthy volunteer subjects.Methodology The study variables were erector spinae myoelectric silence onset and offset (expressed as a percentage of the maximum lumbar flexion value), erector spinae average EMG during myoelectric silence and erector spinae maximum and average EMG during concentric and eccentric phases. Results A significant reduction in the erector spinae average EMG during eccentric contraction and an increase in lumbar flexion at the erector spinae onset were observed following the application of the myofascial technique.Conclusion After a combined intervention of spinal manipulation at L3 level and a myofascial induction technique of the thoracolumbar fascia, the myoelectric silence of erector spinae appears later and its contraction intensity is lower during the eccentric phase. This could be produced by an erector spinae inhibition (AU)

Prediction of digestible energy content of extruded dog food by in vitro analyses.

The aim of this study was to develop a simple and reproducible in vitro method for predicting the apparent energy digestibility of dry extruded dog foods. The proposed method is based on the two-step multienzymatic incubation assay described by [Boisen, S., 1991: In Vitro Digestion for Pigs and Poultry, M. F. Fuller (ed.). CAB International, Wallingford, 135-146], with some modifications adapted to dogs' digestion characteristics. The method consisted in two consecutives incubations, first one during 2 h with pepsin (10 mg/g of food sample) in acid pH and second one during 4 h with pancreatin (100 mg/g of food sample). The undigested residue obtained was collected in a filtration unit and then dried and ashed. The in vitro percentage of organic matter disappearance (in vitro dOM) of 54 dry extruded commercial dog foods was determined and used as predictor of the in vivo apparent organic matter (in vivo dOM) and energy digestibility (in vivo dE) and digestible energy (DE) content. There was a close linear relationship between the in vivo dOM and dE [r(2) = 0.95, residual standard deviation (RSD) = 1.05 and coefficient of variation (CV) = 1.2%] and also between the in vitro and in vivo dOM (r(2) = 0.92, RSD = 1.38 and CV = 1.6%), even if the in vitro dOM overestimated on average by 4% the in vivo dOM. When the in vitro dOM was used to predict the in vivo dE, the relationship between both variables was defined by the equation: in vivo dE (%) = -2.45 + 0.98 +/- 0.04x in vitro dOM (%), (r(2) = 0.92, RSD = 1.25 and CV = 1.5%). In addition, a close relationship between the in vivo and predicted DE (estimated dE x gross energy determined calorimetrically) was found (r(2) = 0.97, RSD = 0.26 and CV = 1.4%). The accuracy of DE content prediction using the proposed in vitro method was higher than that obtained when the DE content of the same set of samples was predicted by the equation proposed by the NRC (1985) (r(2) = 0.76, CV = 4.5%) and also slightly higher than that obtained when using the equation proposed by NRC (2006) (r(2) = 0.95, CV = 2.1%).

[Study of cathepsin D levels in invasive bladder cancer and its stroma. Correlation with tumor stage, cytological grade, lymph node metastasis and survival]. / Estudio de los niveles de catepsina D en el tumor vesical infiltrante y en su estroma, y de su correlación con el estadio tumoral, grado citológico, afectación ganglionar y supervivencia.

OBJECTIVE: The aim of this study was to evaluate cathepsin D as a prognostic marker in invasive bladder cancer and to determine its relationship with stage, grade, lymph-node metastasis and survival too. MATERIAL AND METHODS: An immunohistochemical staining of 32 radical cystectomy specimens suffering from transitional cell carcinoma was performed, using a monoclonal antibody anti-cathepsin D (Novocastra). We made a semicuantitative measurement of the cathepsin D expression in the tumor and in the peritumoral stroma in a 400 x microscopic high power field. Patient population was composed of 31 men and 1 woman with a mean age of 63.25 years. The mean follow up was 23.6 months. Stage was classified with the WHO 1997 classification. Grade was classified with the ISUP/WHO 1998 classification. For the statistical analysis the Chi-square test, Pearson's test R, the Kaplan Meier method and the log-rank test were used. RESULTS: The pathological stages of the surgical specimens were as follows: pTo:3.1% (1), pT1:12.5% (4), pT2:15.6% (5), pT3:34.4% (11). (p < 0.001) A high cytologic grade was found in 81.25% of the tumors. There was a 43.8% progression rate and 40.6% mortality. There was no statistically significant relationship among Cathepsin's D levels in the stroma and lymph node metastases, stage, or grade (p = 0.473, p = 0.604, p = 0.2423). There was no statistically significant relationship among Cathepsin's D levels in the tumor and lymph node metastases, stage or grade (p = 0.496, p = 0.722 and p = 0.461). The cathepsin D levels, neither in the stroma nor in the tumor, showed no influence neither on the disease free intervals nor in the survival rates (p = 0.785; p = 0.355 and p = 0.614; p = 0.601 respectively). CONCLUSIONS: Immunohistochemical Cathepsin D levels do not seem to play a role in the prognostic of transitional tumors of the urinary bladder.

Estudio de los niveles de catepsina D en el tumor vesical infiltrante y en su estroma, y de su correlación con el estadio tumoral, grado citológico, afectación ganglionar y supervivencia / Cathepsin D levels study in invasive bladder cancer and its stroma. Correlation with tumor stage grade, lymph-node metastasis and survival

OBJETIVO: Evaluar la catepsina D como marcador pronóstico en el carcinoma transicional vesical infiltrante y determinar su relación con variables pronósticas reconocidas como son el estadio, el grado y la afectación ganglionar.MATERIAL Y MÉTODOS: Se realizó una tinción inmunohistoquímica de 32 piezas de cistectomía radical afectadas por carcinoma transicional infiltrante, practicadas entre noviembre de 1996 y mayo de 1999, con anticuerpo monoclonal anti catepsina D (Novocastra), realizando una medición semicuantitativa de la expresión de catepsina en las células tumorales y en el estroma peritumoral por campo de 400x.La serie estudiada se compuso de 31 varones y una mujer con un rango de edad entre 41 y 75 años y una edad media de 63,25 años (Desviación estandard de 8,77) y un seguimiento medio de 23,6 meses (1 a 44 meses). Los estadios se clasificaron según la clasificación de la WHO de 1997. El grado citológico se clasificó según la clasificación de la ISUP /WHO de 1998.Para el análisis de las variables se utilizó el test Chi-Cuadrado y test R de Pearson. El test de supervivencia se realizó según el método de Kaplan Meier y los niveles de significado mediante el test del logaritmo del rango (log-rank test).RESULTADOS: Los estadios diagnosticados en el momento de realizar la cistectomía fueron: pTo:3,1 per cent (1), pT1:12,5 per cent (4), pT2:15,6 per cent (5), pT3:34,4 per cent (11), pT4: 34,4 per cent (11). (p<0,001).El 81,25 per cent de los tumores fueron de alto grado citológico y el 18,75 per cent de los tumores fue de bajo grado.Se apreció afectación ganglionar en el 40,7 per cent de los casos.Existió una progresión del 43,8 per cent y una mortalidad del 40,6 per cent.No se encontraron valores significativos de asociación entre el nivel de catepsina en el estroma y el grado de afectación ganglionar, estadio tumoral o grado citológico (p=0,473, p=0,604, p=0,2423 respectivamente), ni con los niveles de catepsina tumoral y los parámetros referidos anteriormente (p=0,496, p=0,722 y p=0,461 respectivamente).Los niveles de catepsina en el estroma y tumor no mostraron influencia en los intervalos libres de enfermedad (p=0,785 y p=0,355 respectivamente) ni sobre la supervivencia (p=0,614 y p=0,601).CONCLUSIÓN: En nuestra serie la determinación semicuantitativa de los niveles de catepsina D con métodos inmunohistoquímicos no aporta información pronóstica en el tumor vesical infiltrante (AU)

Expression of type I interferon receptor in renal cell carcinoma.

Immunohistochemical analysis of INF-R was performed on 110 renal tumors, 25 peritumoral kidney tissues and 10 lymph node metastases. Pathological material was previously studied and classified according to predominant cell type, stage and grade. A statistical analysis was made in order to determine to what extent the immunoexpression of INF-R differed in relation to the histological variables studied. All peritumoral kidney sections, 89/110 tumors and 9/10 metastases proved positive. Membranous expression was related to clear cell carcinomas. Type I INF-R is expressed in RCC, independent of tumor stage and grade, as well as sex, age and survival. INF-R is widely expressed in RCC in any tumoral type, and its expression is preserved in metastatic disease, which may help to target those patients who could benefit from INF therapy.

Proliferating cell nuclear antigen (PCNA) as a prognostic factor in renal cell carcinoma.

BACKGROUND: A retrospective study was performed on patients with renal cell carcinoma to determine whether tumoral proliferating cell nuclear antigen (PCNA) is a predictive factor. METHODS: We studied immunohisto-chemical PCNA expression with pc10 monoclonal antibody in 109 renal tumor paraffin sections. These tumors were previously classified according to cellular type by Thoenes, Furman's grading and Robson's staging, Moreover, we counted the number of mitoses in 10 high power fields (HPF) and also evaluated the tumoral necrosis percentage. Ten year survival curve of Kaplan and Meier was obtained for 90 patients. RESULTS: Nuclear immunostaining for PCNA showed a statistical correlation with Robson's stage, cellular type and nuclear grade. Moreover, the number of positive nuclei was higher in tumors presenting an elevated mitosis count and higher in degree of necrosis. Survival was significantly poorer in patients whose PCNA index was greater than 5%. Nuclear PCNA immunostaining was shown to be an independent prognostic factor in patients with Robson stage I and also in those who had high cytological grading. CONCLUSIONS: These results show PCNA to be a prognostic marker for RCC.

[Intervention in risk factors and protection of target organs]. / Intervención sobre los factores de riesgo y protección de órganos diana.

The aim of this work is to review the role of the main risks factors in relation to cardiovascular diseases, and to evaluate the relative effectiveness of different preventive strategies. In the first part of the paper we summarize the historical background that allows us to understand the magnitude of this problem and its evolution. Secondly, we evaluate the significance of these strategies in the primary prevention of stroke and myocardial infarction, and how an intervention in one risk factor can have a greater significance for one of these events. But in any case, we must consider the whole benefit in each patient's health in our final evaluation of this intervention. Finally, we describe the strategies for hypertension and diabetes in order to reduce the incidence of end renal disease.

[Familial outbreak of pneumonia by psittacosis]. / Brote familiar de neumonía por psitacosis.

A familial outbreak (4 cases) of pneumonia by psittacosis in Vall de Uxó (Castellón) during the month of April in 1990 is described. In addition to the epidemiologic, clinical and serologic (complement fixation) studies carried out a survey and serology of 11 healthy controls (neighbors, and employees from a bird shop) were performed. The serum of a parrot recently acquired by the patients (positive at 1/8) was analyzed. The habit of petting the animal was significantly associated with the disease. The patient's response to treatment was good. The titers of antibodies versus Chlamydia psittaci were higher than those of the controls examined and the established threshold for positivity (1/36). In addition to clinical intervention the roles of epidemiology and the participation of veterinary services are fundamental to control this disease the exact prevalence of which is unknown.

Correlation between serum values of prostatic acid phosphatase and morphometric analysis in the cytologic diagnosis of prostatic carcinoma.

We studied 78 men with suspicion of prostatic carcinoma, who underwent transrectal aspiration biopsy, diagnosing 46 adenocarcinoma, 13 chronic prostatitis and 19 benign prostatic hyperplasia. Moreover, we determined prostatic acid phosphatase (PAP) by enzyme immunoanalysis, resulting in 9/78 false-positives and 18/78 false-negatives. Also, we carried out a morphometric analysis of the cytologic samples which showed good correlation with the cytologic diagnosis except in the moderately differentiated carcinomas. We found a good correlation between PAP values, cytologic diagnosis and nuclear size as well as the percentage of the binucleolated cells.

[Segmental kidney dysplasia]. / Displasia renal segmentaria.

The frequency of segmental renal dysplasia was studied in 15 patients with complete pyeloureteral duplication whose anatomopathologic diagnosis of the lesions of some of the renal segments of duplication were available (14 partial nephrectomies, one open renal biopsy). Evidence of dysplasia was found in 10 cases (67%), the remaining 5 were diagnosed as having chronic pyelonephritis. All patients had a coexisting ureteric anomaly that drained the dysplastic renal segment: 6 ureteral ectopias, 3 ectopic ureteroceles, 1 vesicoureteral reflux. The clinical and pathogenic importance of the associated anomalies of the excretory tract, the diagnostic difficulties arising from the minimally- or non-functioning dysplastic renal segment, and the therapeutic modalities utilized are discussed.

[The Ask-Upmark kidney: a form of reflux nephropathy]. / El riñón de ASK-Upmark: una forma de nefropatía del reflujo.

We present six female patients aged 14 to 47, all diagnosed histopathologically as suffering from Ask-Upmark Kidney and who had clinical manifestations of severe arterial tension associated with urinary infection in four cases. Mictional Cystourethrography was carried out in all cases, and four of them displayed vesicoureteral reflux in the small kidney. Although this pathology has classically been considered a congenital malformation in the context of renal hypoplasias (segmental hypoplasia), the observation of glomerular traces with PAS staining in the renal segments regarded classically as "aglomerular" and the frequent association of this pathology with vesicoureteral reflux point significantly towards Ask-Upmark Kidney being a form of reflux nephropathy. Nephrectomy cured the arterial hypertension in half the cases, and the factors with prognostic importance in this respect are commented upon.

[Effects of urologic surgery on lymphocyte blastogenic response to phytohemagglutinin]. / Efectos de la cirugía urológica sobre la respuesta blastogénica linfocitaria a la PHA.

In order to study the effect of urological surgery on the defence system, we have evaluated the postoperative evolution of the lymphocyte blastogenic response to phytohemagglutinin (PHA) in 45 patients. 25 of them were subjected to a transurethral resection (TUR) of a vesical tumour, 10 to a transvesical prostatectomy, 6 to a pyelolithotomy and 4 to a nephrectomy due to renal atrophy secondary to lithiasis. We verified a significant drop in the lymphocyte blastogenic response to PHA at 2-4 hours of transvesical prostatectomy (p less than 0.001) and of pyelolithotomy and nephrectomy (p less than 0.001) which was sustained until the fourth and second day after operation respectively, with subsequent return to normal. However, lymphocyte blastogenic response to PHA did not vary significantly during the postoperative of patients subjected to a TUR of vesical tumours. On the whole, the degree and duration of postoperative immunodepression was dependent on the intensity of the surgical traumatism.

[Renal dysplasia and vesico-ureteral reflux]. / Displasia renal y reflujo vesicoureteral.

We studied two groups of patients in order to evaluate the frequency of association between renal dysplasia and vesicoureteral reflux. The first was composed of 19 patients with dysplastic kidneys, 15 of whom were studied by means of micturition cystourethrography. The second group was made up of 86 patients with 124 kidneys with reflux. In 16 of these we were able to obtain a histopathological diagnosis of the renal lesions (12 nephrectomies, 4 biopsies). In three cases the renal dysplasia was associated with a vesicoureteral reflux, which represents an incidence of reflux in 20% of the patients with renal dysplasia, and an incidence of dysplasia in 19% of the kidneys with reflux examined histopathologically. We contrast these results with the literature, discussing the pathogenic hypotheses that enable us to explain this association as well as the clinical consequences thereof.

[Effects of urologic surgery on lymphocyte subpopulations]. / Efectos de la cirugía urológica sobre las subpoblaciones linfocitarias.

We studied the postoperative development of lymphocytes, T cells and lymphocyte subpopulations, in peripheral blood in 45 patients. Twenty-five of them were subjected to a TUR of a bladder tumor, 10 to a transvesical prostatectomy, 6 to a pyelolithotomy and 4 to a nephrectomy for renal atrophy secondary to lithiasis. We confirm a significant postoperative drop in the lymphocyte count and in the percentages of OKT 3+ (total T cells), OKT 4+ (helper T cells) and OKT 8+ cells (cytotoxic/suppressor T cells) 2-4 hours after the operation. Its duration varies according to the type of operation carried out. Despite the slight differences observed in the postoperative development of the lymphocyte subpopulations, at no time in the study did we report significant postoperative variations in the OKT 4+/OKT 8+ quotient.

[Treatment of advanced prostatic carcinoma with ketoconazole. Our experience in 10 cases]. / Tratamiento del carcinoma prostático avanzado con ketoconazol. Nuestra experiencia en diez casos.

We have treated 10 patients with histologically diagnosed prostate carcinoma, in states C and D, with orally administered dosage of 1200 mg./day of ketoconazol, with the following results: Four patients were excluded through displaying gastrointestinal intolerance in the first days of treatment. Three patients treated had the dosage reduced to half due to poor tolerance, but no improvement was noted. Another three patients tolerated the treatment for four months and displayed transitory remission of ostealgia, which permitted the withdrawal of analgesics. In these patients the treatment was suspended due to digestive intolerance and to the appearance of a clinical picture compatible with suprarrenal corex hypoadrenalism.